3520-13B Supplemental Additive Manufacturer Annual Report

EPA Form 3520-13B (05-02-2018) Supplemental Additive Manufacturer Annual Report
* Required Field

Page 1 of 1
Form Approval
OMB No. 2060-0150
Approval Expires 01/31/2020

U.S. Environmental Protection Agency
Office of Transportation and Air Quality

Supplemental Additive Manufacturer Annual Report
* 1. Company ID:

* 2. Report Year:

Leave Blank

* 3. Report Type: (Check Only One)
Resubmission

Original
6. Production Values:

a. Additive ID:

b. Market:
A - Aftermarket
B - Bulk
C - Don't Know

Mail the completed form to:
U.S. Environmental Protection Agency
William Jefferson Clinton Building
Mail Code - 6405A
1200 Pennsylvania Avenue, NW
Washington, DC 20460
Program Support:
Telephone (202) 343-9648
Fax (202) 343-2825
Email: caldwell.jim@epa.gov
Email: solar.jose@epa.gov
https://www.epa.gov/fuels-registration-reporting-and-compliance-help

C. Production Volume

d. Production Units:
gal - Gallons
lb - Pounds
kg - Kilograms

or, via courier:
U.S. Environmental Protection Agency
William Jefferson Clinton Building - North
Room 5512D; (202) 343-9038
1200 Pennsylvania Ave, NW
Washington, DC 20004

This office is operated by a contractor, CSRA LLC, a General Dynamics Information
Technology company, for the EPA.